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STRUCTURE INFORMATION: �7ype of Construction <br /> - 1.Structure Dimenslons ,/ 1.Structure Dimensions(continued) <br /> �1 / <br /> �' Number of bedrooms= ❑Wood 1 Frame <br /> a.Length(ft-)= []pAasonry <br /> b.Widlh(fl.)� Number ot garage stalls. �Metal <br /> qreas in sauare teet <br /> Attached=_._ �Pole Bldg. <br /> Detached=__ ❑ICF <br /> c.Basement= �p�_�}�e Prefab <br /> � �a 1 <br /> d•1'�Sl°ry " �Off-slle Pretab � <br /> e.2'�Story= ❑Other(please specify)� r � <br /> f. %Story = . <br /> g.Tolal Area= <br /> REQUIRED SUBMITTALS: <br /> Ail of the information Nu��t be submitted in order for our a lication to be rocesse ' <br /> Enclos A Ilcable <br /> p Permit A lication <br /> p Pro osed Buikl�n P�ans <br /> � ❑ MN 31ate Ene Code Calculatio�s end Mechanical Code Re uirements orm <br /> � ❑ Surve meeti� ell re uiroments <br /> � p Stortnwaler PolluCron PrevenGo�Plan <br /> � ❑ HardcoverCalwlation s <br /> � p Sa tic S stem Site Evaluetfon Re ort <br /> � p Access Pertnit <br /> � p Wetland Bufier Im rovement Plan <br /> � ❑ En ineered Plans for Relainin Walls 4 feel or above <br /> O p Minnehahe Creek Wetershed District Pertnit s <br /> � ❑ Plan Review Fee <br /> � qpp�icatlon Esuow&Agreement <br /> 0 <br /> � p Othec <br /> qppLICANTIOWNER ACKNOWLEDGEMENT: <br /> Agrees to provide all intortnation required or requested by lhe Building Department; <br /> . Aprees to pay ths City of Orono for englneering eonsulUnt review costs In excess of 5500; <br /> . CertiOes ihat the Information supplled is true and��i��'on being aware'hal upon ai u9re loTdo so,Pthe staN ha nno el emal ve <br /> are solely responsible For submflling a wmpleta app <br /> but to reject il unGl it Is complete; leted and signed, <br /> Acknowladges the Escrow Agreement is comp ����ion is dassi8ed by Slate law as eilher <br /> blic hul can be given lo lhe subject <br /> • Understands some or ell af Ihe infortnaGon thet you are asked to provide en to'elher the public w the subject of the dala. O�� <br /> • privale or confidenUal. Privale deta is in(ormalion which generelly cannot 6e given lo the P� o�mmenlal agencies <br /> ate our records and records of other g <br /> of the dala. Confidential deta is infortnation which penerally cannot be g <br /> 1 lhe in(ortnalian,we applicalion may not be issued. <br /> purpose end intended use of lhls infortnation is ta anrwally u <br /> required by lew. I(you refuse lo suPP Y <br /> revent the comptetion be iss Qd uipon rsceipt of atS10,000 <br /> Y <br /> . qgrees that in the event that weather or othar�c��d Certiflcata of Occupanoy maY <br /> CeAificate of Occupancy is requasted,a temP N <br /> escrow to ensure completion of the as-buflt survey and alI cite improvementa. <br /> �j---Z G - / �-/ <br /> � — Date'. <br /> ppplicant's Signature: !— ,__.� � Date: � � U _ r y <br /> pwners Signa u�t r ' <br /> —�_ <br />